Original articleGeneral thoracicCadaveric Lobar Lung Transplantation: Technical Aspects
Section snippets
Patients and Methods
Since the inception of our lung transplant program in 1990 to the end of February 2012, we have performed 885 lung transplants. Of these, 569 bilateral sequential, 253 single, and 63 heart-lung transplants have been performed. In 2005, in an effort to improve the waiting list servicing of smaller recipients, we decided to perform lobar transplantation in a select group of recipients when size mismatching occurred. Since then, we have become the national pediatric lung transplant center and have
Results
Analysis of the TLC ratio between donors and recipients shows a variation from 0% to 300% discrepancy (Table 1). Eight patients had a predicted TLC discrepancy of less than 20%, but the recipient chest cavity size mandated lobar reduction. These patients tended to have either bronchiectasis or pulmonary fibrosis.
The lobectomies performed are outlined in Table 2. Thirteen patients required CPB during the operation, instituted for a variety of reasons including awake institution of peripheral CPB
Comment
The use of cadaveric lobar transplant is not widespread, despite the advantages this gives to size disadvantaged and urgent waiting list candidates. The published literature consists of only a few case series of cadaveric lobar transplants, most of which have been performed in high volume lung transplant centers [3, 5, 6, 7, 8, 9, 10, 11]. We have demonstrated a correlation between transplanted D/R TLC ratio and both % predicted FVC and FEV1. This has not been previously reported in a cadaveric
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